Therapy with m-TOR inhibitors decreases the response to the pandemic influenza A H1N1 vaccine in solid organ transplant recipients.

Concern has been raised regarding the response to vaccination in solid organ transplant recipients (SOTR) undergoing immunosuppressant regimens and the possibility of rejection related to the immune response associated with pandemic influenza H1N1-2009 vaccination. The goal of this study was to assess the immunogenicity, efficacy and safety of the pandemic vaccine in SOTR. We performed a multicenter prospective study in SOTR receiving the pandemic vaccine. Immunological response was determined in serum 5 weeks after vaccination by microneutralization assays, and immunoglobulins were measured by ELISA. Three hundred and forty-six SOTR were included. Preexisting seroprotection was detected in 13.6% of cases and rates of seroconversion and seroprotection after vaccination were 73.1% and 82.9%, respectively. Patients with baseline antibody titers had better geometric mean titers (GMT)-post after pandemic vaccination (339.4 vs. 121.4, p < 0.001). Younger age, liver disease and m-TOR inhibitor therapy were independently associated with lower seroprotection and GMT-post. There were no major adverse effects or rejection episodes. Pandemic vaccine was safe in SOTR and elicited an adequate response, although lower than in healthy individuals. This is the first study describing a decreased response after vaccination in patients receiving mTOR inhibitors who presented lower seroprotection rates and lower GMT-post.

[The intra bone passage and nursing]. / La vía intraósea y enfermería.

The authors confirm the utility of the intra bone passage as a means of emergency vascular access when the installation of a peripheral and/or central venous passage is difficult or impossible when attending critically ill patients as another additional technique available to Nursing when caring for a critically ill patient. From the reference articles reviewed, the authors deduce that intra bone vascular access provides a passage to the vascular system which permits rapid, easy and efficient access, especially when attending children under the age of six. The use of the intra bone passage is justified whenever medical personnel take more than 90 seconds or have three failed tries to insert a peripheral venous tube in patients who are critically ill or unstable. The anatomical zones which are the most appropriate to puncture in children are the proximal and distal part of the tibia and the distal section of the femur. This intra bone passage permits the administering of liquids and drugs, just as a peripheral venous passage does. Both the complications and the countermeasures are minimal.

Reduced incidence of pneumonia in influenza-vaccinated solid organ transplant recipients with influenza disease.

Whether influenza vaccination influences the severity of illness in cases of clinical failure in solid organ transplant (SOT) recipients receiving influenza vaccine has not been extensively studied. Our goal was to evaluate the frequency of influenza vaccination among SOT recipients with influenza disease and its impact on the illness severity during the 2010-2011 season. Adult SOT recipients with confirmed influenza infection were included from December 2010 to April 2011. Follow-up data were recorded and antibody titres were determined using a microneutralization assay. Sixty-four SOT recipients were included in the study, ten (15.6%) with severe disease, requiring admission to intensive care units, of whom four (6.3%) died. In all, 34 (53.1%) received the 2010-2011 seasonal influenza vaccine and 32 (50.0%) received the 2009-H1N1 pandemic vaccine, and none had detectable antibodies against influenza at the time of diagnosis of influenza infection. Twenty-three (67.6%) of the patients that received the vaccine required hospital admission and presented less dyspnoea (10, 29.4% versus 14 (50.0%), p 0.09) and pneumonia (8, 23.8% versus 15, 50.0%, p 0.03, relative risk 0.3, 95% CI 0.1-0.9) than unvaccinated patients, with relative risk reductions of 60% and 70%, respectively. Although influenza vaccination confers protection on SOT recipients against developing influenza pneumonia, the rate of clinical failure is still high. New strategies to improve influenza immunization are needed for this group of patients.

La vía intraósea y enfermería / The intra bone passage and nursing

Se confirma la utilidad de la vía intraósea como acceso vascular de emergencia cuando la instauración de la vía venosa periférica y/o central se hace difícil o imposible en la atención a pacientes críticos, como otra técnica más de Enfermería en la atención al paciente crítico. De la bibliografía revisada se deduce que el acceso vascular intraóseo constituye una vía de acceso rápida, fácil y eficaz al sistema vascular, sobre todo en los niños menores de 6 años. La utilidad de la vía intraósea está justificada cuando se tarda más de 90 segundos o tras tres intentos fallidos de canalización venosa periférica en pacientes críticos o inestables. Las zonas anatómicas más adecuadas de punción en niños son la porción proximal y distal de la tibia y el fémur distal. Permite la administración de líquidos y fármacos igual que la vía venosa periférica. Tanto las complicaciones como las contraindicaciones son escasas (AU)

Luxación atlo-axoidea con fractura de la apófisis odontoides tipo II / Atlanto-axoideal luxation with type II fracture of the apohysis ondontoides

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